Shovel incisors, three-rooted molars, talon cusp, and supernumerary tooth in one patient.

2 Additionally, multiple dental anomalies have been reported in individuals and within families, without evidence of other systemic manifestations. Ekman-Westborg and Julin3 reported a case of macrodontia, multituberculism, central cusps and pulp invaginations in the permanent dentition. Reportedly, no hereditary factors were found. Mann et al.^ reported a variant of the Ekman-Westborg-Julin syndrome, discovered as part of an archaeological exploration. The skull of a 5-year-old Native American exhibited macrodontia, shovel-shaped maxillary central incisors, three-rooted mandibular primary molars, dens invaginatus, agenesis of maxillary permanent canines, and crenulated occlusal surfaces of the first permanent and second primary molars. Interestingly, only one of the other 56 skeletons unearthed exhibited any dental anomalies; one adult male had peg-shaped third molars. Casamassimo et al.^ reported the simultaneous occurrence of microdontia, taurodontia, and dens invaginatus in a family. The distribution of cases in this family suggested an X-linked recessive transmission. Three-rooted mandibular molars in the primary or permanent dentition, talon cusp, shovel-shaped incisors, and mesiodens, individually have been previously reported. The simultaneous occurrence of these anomalies, however, has not been reported previously.